Pratuangtham, Surasak

Pratuangtham, Surasak is an individual health care provider with primary practice located at 4440 W 95Th St , Oak Lawn IL 60453-2600. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Infectious Diseases, which is considered as his primary health care specialty. Pratuangtham, Surasak can be contacted via phone (708) 727-1267.

Contact Information

Primary practice address
4440 W 95Th St Oak Lawn IL 60453-2600
Phone: (708) 727-1267
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Infectious Diseases 2080P0208X 036085443 Illinois

Profile Details

NPI number 1639164601
LBN Legal business name Pratuangtham, Surasak
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 15th, 2005
Last updated Dec 22nd, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639164601 NPPES
Illinois Other 01626483 BCBS PROVIDER ID
Illinois MEDICAID 036085443 BCBS PROVIDER ID
Illinois Other 25601 BCBS PROVIDER ID
Illinois MEDICAID 200331500A BCBS PROVIDER ID

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